Hospital-at-home, a trademarked name of Johns Hopkins Medicine, is a model that transforms the patient home into an environment that delivers hospital-level care using a unique methodical combination of people, processes, and technology.
While these models are complex to implement, they have proven great clinical and financial outcomes. For example, hospital-at-home has reduced complications while cutting the cost of care by 19-30% compared to traditional inpatient care. Key measures include facilitating earlier discharges, reducing inpatient costs, and reducing risks associated with being admitted to a hospital environment.
We dive into three key considerations and a handful of challenges to consider when implementing a hospital-at-home model.
#1. RPM capabilities will maximize the complexity of patients that can be managed in the home.
Remote patient monitoring (RPM) technologies that help manage a patient’s chronic condition/conditions at home can be largely used for hospital-at-home applications. This is particularly useful since clinicians typically use care pathways, including illness-specific care maps, clinical outcome evaluations, and specific discharge criteria when implementing a hospital-at-home program.
Thus, a robust RPM solution has the potential to support more complex models by tailoring care pathways and protocols to individual patients. RPM enables care through synchronous and asynchronous virtual interactions in the home and provides essential data elements for clinical evaluation and assessment, which can maximize the performance of a care pathway.
#2. Consider specific care pathways that are appropriate for a hospital-at-home model.
Not all patients are appropriate for these care models. Clinical and financial analysis must be considered when designing which care pathways are appropriate. Ensuring all clinical needs can be met in a home environment and accounting for unexpected emergencies in specific patient populations is essential.
Many times, the depth and breadth of the resources that are foundational in a hospital environment can be overlooked when making this assessment. An example of this is on-demand pharmacy services when medication intervention is needed. Identifying these at the forefront will help design processes that may need to become part of an organization’s hospital-at-home pathway.
#3. Evaluate how virtual, digital, and in-person tools can be used synergistically to provide care.
Now that we have identified that designing these programs can be complex and must account for the unexpected, a combination of virtual tools, digital information and technology, and in-person care is needed to help meet patients’ needs and create efficiencies.
Organizations must utilize a matrix approach from multiple teams and departments to replicate the multidisciplinary environment of the hospital. Leveraging virtual and RPM programs will maximize patient eligibility and increase provider comfort and buy-in.
Key challenges to consider
Program eligibility requires a suitable home environment.
It is essential to evaluate a patient’s home environment when determining eligibility. At-home care may not be a good fit for patients who live alone or who have social determinants of health issues. Assessing if patients have a support system to ensure, for example, adequate meals, medical equipment needs, and medication adherence, as well as the elements in Maslow's hierarchy of needs is essential. If not, this may limit a patient's ability to be cared for in the home. However, partnerships with community services or delivery services may be needed to prevent eligibility challenges.
Creating a successful program requires financial- and executive-level buy-in for resources and funding.
These programs are many times, in theory, built to alleviate high brick and mortar costs. If they haven’t already, hospitals must be willing to invest in skilled nursing staffing (24/7 staffing support is essential), telehealth, and other technologies to coordinate care delivery. Looking to staffing partnerships may alleviate some of these challenges and be a more cost-effective option.
Hospital-at-home is an opportunity for the healthcare delivery system to effectively care for certain types of patients at home. This can improve their individual experiences, conserve health system resources, and improve clinical outcomes all at the same time.
Want to learn more about how Veta Health supports hospital-at-home? Our personalized care pathways are tailored to individual patients, allowing our partners to implement robust RPM programs. Click here to set up some time to chat.